[Novel endoscopic antireflux procedures - time for critical appraisal]

GERD is the most prevalent gastrointestinal disorder in the Western world and the extent of anatomic alterations underlying the mechanisms of GERD can be viewed upon as a spectrum from a single anatomic alteration (e.g.  incompetent lower esophageal sphincter) to multiple anatomic alterations, such as diaphragmatic hiatal hernia. The degree of anatomic aberrations also seem to correlate with the complications of GERD. Since GERD is a heterogenous disease, it can be argued that its treatment should be individualized. The medical and surgical therapies have been the mainstay of long-term treatment of GERD, but during recent decades several Food and Drug Administration (FDA)-approved devices have become available for endoscopic treatment of GERD, thus potentially filling the alleged therapeutic gap between medication and surgery. Endoscopic treatment options are now considered appropriate treatment in particular in patients early in the GERD spectrum. However, serious methodological concerns can be raised regarding the scientific documentation behind all of these devices, despite the fact that they are vigorously marketed. This article outlines the basic principles and guidelines for the current and future documentations of such devices, which might be helpful for the clinician in selecting the most accurate long-term therapeutic alternative for patients with chronic GERD.